Provider Demographics
NPI:1699594515
Name:OLIVER, STEPHANIE (LPC, ATR-P, CADC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LPC, ATR-P, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 N HUMBOLDT BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4948
Mailing Address - Country:US
Mailing Address - Phone:219-718-1405
Mailing Address - Fax:
Practice Address - Street 1:1850 N HUMBOLDT BLVD APT 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4948
Practice Address - Country:US
Practice Address - Phone:219-718-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty